Bronchiolar Disorders: Classification and Diagnostic Approach

Poletti, Venerino; Costabel, Ulrich

doi:10.1055/s-2004-815597

Cited by 19 publications

(2 citation statements)

References 19 publications

(26 reference statements)

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“…Because of the variable findings of noninvasive diagnostic testing, lung biopsy is performed on some workers suspected of having flavoring-related lung disease. The diagnosis commonly associated with flavoring-related lung disease, obliterative bronchiolitis, stems from the pathologic findings from some lung biopsies in workers exposed to flavorings: destruction of the small airways marked by concentric fibrosis of the bronchioles ( 3 ). Similar to the noninvasive diagnostic testing, not all lung biopsies on exposed workers demonstrate these characteristic findings.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike other known occupational causes of obliterative bronchiolitis, acute symptoms in these cases did not follow a recognized overwhelming exposure; rather, clinical progression was insidious, marked by exertional dyspnea and airflow obstruction that did not improve significantly following bronchodilation (fixed obstruction). The few cases that underwent biopsy had histopathologic findings consistent with obliterative bronchiolitis ( 2 ), typically characterized by concentric fibrosis and destruction of the bronchioles ( 3 ). Since the sentinel microwave popcorn plant was identified, additional cases of indolent onset clinical bronchiolitis obliterans have been diagnosed, often without biopsy, in workers in a number of other industries, including flavoring manufacturing, food (other than popcorn) production, and coffee roasting and packaging ( 4 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Flavoring-Related Lung Disease in a Coffee Roasting and Packaging Facility Worker With Unique Lung Histopathology Compared With Previously Described Cases of Obliterative Bronchiolitis

Harvey

Hawley

Korbach

et al. 2021

Front. Public Health

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Occupational exposure to diacetyl, a butter flavor chemical, can result in obliterative bronchiolitis. Obliterative bronchiolitis is characterized by exertional dyspnea, fixed airflow obstruction, and histopathologic constrictive bronchiolitis, with bronchiolar wall fibrosis leading to luminal narrowing and obliteration. We describe a case of advanced lung disease with histopathology distinct from obliterative bronchiolitis in a 37-year-old male coffee worker following prolonged exposure to high levels of diacetyl and the related compound 2,3-pentanedione, who had no other medical, avocational, or occupational history that could account for his illness. He began working at a coffee facility in the flavoring room and grinding area in 2009. Four years later he moved to the packaging area but continued to flavor and grind coffee at least 1 full day per week. He reported chest tightness and mucous membrane irritation when working in the flavoring room and grinding area in 2010. Beginning in 2014, he developed dyspnea, intermittent cough, and a reduced sense of smell without a work-related pattern. In 2016, spirometry revealed a moderate mixed pattern that did not improve with bronchodilator. Thoracoscopic lung biopsy results demonstrated focal mild cellular bronchiolitis and pleuritis, and focal peribronchiolar giant cells/granulomas, but no evidence of constrictive bronchiolitis. Full-shift personal air-samples collected in the flavoring and grinding areas during 2016 measured diacetyl concentrations up to 84-fold higher than the recommended exposure limit. Medical evaluations indicate this worker developed work-related, airway-centric lung disease, most likely attributable to inhalational exposure to flavorings, with biopsy findings not usual for obliterative bronchiolitis. Clinicians should be aware that lung pathology could vary considerably in workers with suspected flavoring-related lung disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case Report: Flavoring-Related Lung Disease in a Coffee Roasting and Packaging Facility Worker With Unique Lung Histopathology Compared With Previously Described Cases of Obliterative Bronchiolitis

Harvey

Hawley

Korbach

et al. 2021

Front. Public Health

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Obliterative Bronchiolitis

Silva¹,

Müller²

2008

CT of the Airways

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Obliterative bronchiolitis (OB) is a condition characterized by inflammation and fibrosis of the bronchiolar walls resulting in narrowing or obliteration of the bronchiolar lumen. The most common causes are childhood lower respiratory tract infection, hematopoietic stem cell or lung and heart-lung transplantation, and toxic fume inhalation. The most frequent clinical manifestations are progressive dyspnea and dry cough. Pulmonary function tests demonstrate airflow obstruction and air trapping. Radiographic manifestations include reduction of the peripheral vascular markings, increased lung lucency, and overinflation. The chest radiograph, however, is often normal. High-resolution CT is currently the imaging modality of choice in the assessment of patients with suspected or proven OB. The characteristic findings on high-resolution CT consist of areas of decreased attenuation and vascularity (mosaic perfusion pattern) on inspiratory scans and air trapping on expiratory scans. Other CT findings of OB include bronchiectasis and bronchiolectasis, bronchial wall thickening, small centrilobular nodules, and three-in-bud opacities. Recent studies suggest that hyperpolarized 3 He-enhanced magnetic resonance imaging may allow earlier recognition of obstructive airway disease and therefore may be useful in the diagnosis and follow-up of patients with OB.

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